Provider First Line Business Practice Location Address:
33442 1ST WAY S STE 101
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:
98003-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-355-6966
Provider Business Practice Location Address Fax Number:
206-315-0641
Provider Enumeration Date:
01/27/2011