Provider First Line Business Practice Location Address:
34503 9TH AVE SOUTH
Provider Second Line Business Practice Location Address:
#220
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-383-5777
Provider Business Practice Location Address Fax Number:
253-627-0855
Provider Enumeration Date:
05/08/2007