Provider First Line Business Practice Location Address:
33442 1ST WAY S
Provider Second Line Business Practice Location Address:
STE 101
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:
206-470-9842
Provider Business Practice Location Address Fax Number:
206-826-9203
Provider Enumeration Date:
12/03/2012