Provider First Line Business Practice Location Address:
35535 6TH PL SW
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:
98023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-5445
Provider Business Practice Location Address Fax Number:
253-874-0687
Provider Enumeration Date:
08/27/2009