Provider First Line Business Practice Location Address:
33301 9TH AVE SO. SUITE 125
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-6361
Provider Business Practice Location Address Fax Number:
253-838-1750
Provider Enumeration Date:
08/28/2012