Provider First Line Business Practice Location Address:
34512 16TH AVE S STE C
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:
98003-6802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-237-1530
Provider Business Practice Location Address Fax Number:
253-237-1479
Provider Enumeration Date:
11/09/2017