Provider First Line Business Practice Location Address:
33919 9TH AVE S STE 101B
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:
98003-6736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-347-3745
Provider Business Practice Location Address Fax Number:
253-252-2415
Provider Enumeration Date:
01/24/2014