Provider First Line Business Practice Location Address:
32123 1ST AVE S STE A4
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:
98003-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-253-3761
Provider Business Practice Location Address Fax Number:
253-874-5024
Provider Enumeration Date:
11/14/2006