Provider First Line Business Practice Location Address:
34515 9TH AVE 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:
98003-6761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-944-7966
Provider Business Practice Location Address Fax Number:
253-944-7924
Provider Enumeration Date:
01/10/2006