Provider First Line Business Practice Location Address:
33516 9TH AVE S
Provider Second Line Business Practice Location Address:
BLDG 1
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-2501
Provider Business Practice Location Address Fax Number:
253-838-1354
Provider Enumeration Date:
10/19/2005