Provider First Line Business Practice Location Address:
34509 9TH AVE S STE 104
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:
98003-8707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-5140
Provider Business Practice Location Address Fax Number:
253-750-6100
Provider Enumeration Date:
08/25/2005