Provider First Line Business Practice Location Address:
34616 11TH PL S
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-927-2150
Provider Business Practice Location Address Fax Number:
253-927-2851
Provider Enumeration Date:
07/11/2012