Provider First Line Business Practice Location Address:
33301 9TH AVE S STE 125
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:
98003-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-6361
Provider Business Practice Location Address Fax Number:
253-838-1750
Provider Enumeration Date:
01/06/2006