Provider First Line Business Practice Location Address:
33600 6TH AVE SO
Provider Second Line Business Practice Location Address:
SUITE - 102
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-3232
Provider Business Practice Location Address Fax Number:
253-838-6063
Provider Enumeration Date:
05/23/2012