Provider First Line Business Practice Location Address: 
33405 8TH AVE S UNIT 200
    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: 
98003-6639
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
253-833-7444
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/06/2020