Provider First Line Business Practice Location Address:
32040 23RD AVE S
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-529-1935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006