Provider First Line Business Practice Location Address:
30821 PACIFIC HWY S
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:
98003-4995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-839-8608
Provider Business Practice Location Address Fax Number:
253-941-6821
Provider Enumeration Date:
09/11/2007