Provider First Line Business Practice Location Address:
34630 11TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-2455
Provider Business Practice Location Address Fax Number:
253-835-5933
Provider Enumeration Date:
07/10/2009