Provider First Line Business Practice Location Address:
33838 PACIFIC HWY S STE B101
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:
98003-6887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-4363
Provider Business Practice Location Address Fax Number:
253-838-8805
Provider Enumeration Date:
10/16/2012