Provider First Line Business Practice Location Address:
181 S 333RD ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-7363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-1700
Provider Business Practice Location Address Fax Number:
253-661-4565
Provider Enumeration Date:
08/19/2005