Provider First Line Business Practice Location Address:
34616 11TH PLACE SO
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-952-7277
Provider Business Practice Location Address Fax Number:
253-952-7280
Provider Enumeration Date:
08/19/2006