Provider First Line Business Practice Location Address:
33130 PACIFIC HWY S STE 6
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:
98003-6440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-335-2730
Provider Business Practice Location Address Fax Number:
253-661-0030
Provider Enumeration Date:
10/05/2006