Provider First Line Business Practice Location Address:
33811 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:
98003-6707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-533-9050
Provider Business Practice Location Address Fax Number:
253-517-7706
Provider Enumeration Date:
04/30/2007