Provider First Line Business Practice Location Address:
34509 9TH AVE S STE 306
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:
98003-8710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-242-5293
Provider Business Practice Location Address Fax Number:
253-944-4004
Provider Enumeration Date:
05/12/2013