Provider First Line Business Practice Location Address:
32001 32ND AVE S
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-326-6877
Provider Business Practice Location Address Fax Number:
253-322-4687
Provider Enumeration Date:
05/22/2007