Provider First Line Business Practice Location Address:
34503 9TH AVE S
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-835-6260
Provider Business Practice Location Address Fax Number:
253-835-6299
Provider Enumeration Date:
08/23/2006