Provider First Line Business Practice Location Address:
34612 6TH AVE S STE 200
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:
98003-8723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-2520
Provider Business Practice Location Address Fax Number:
253-661-2694
Provider Enumeration Date:
03/23/2013