Provider First Line Business Practice Location Address:
1520 S DASH POINT RD STE B
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-4648
Provider Business Practice Location Address Fax Number:
253-946-4649
Provider Enumeration Date:
11/17/2006