Provider First Line Business Practice Location Address:
32105 1ST AVE S STE B3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-219-1231
Provider Business Practice Location Address Fax Number:
253-838-2560
Provider Enumeration Date:
02/11/2019