Provider First Line Business Practice Location Address:
33305 1ST WAY S STE B212
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:
98003-4554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-344-1840
Provider Business Practice Location Address Fax Number:
253-344-1959
Provider Enumeration Date:
06/09/2008