Provider First Line Business Practice Location Address:
33301 9TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-952-8833
Provider Business Practice Location Address Fax Number:
253-952-8866
Provider Enumeration Date:
09/10/2007