Provider First Line Business Practice Location Address:
34004 16TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-312-0883
Provider Business Practice Location Address Fax Number:
253-719-8128
Provider Enumeration Date:
04/14/2006