Provider First Line Business Practice Location Address:
33710 9TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-1612
Provider Business Practice Location Address Fax Number:
253-815-8851
Provider Enumeration Date:
07/12/2010