Provider First Line Business Practice Location Address:
33600 6TH AVE S
Provider Second Line Business Practice Location Address:
STE. 212
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-0181
Provider Business Practice Location Address Fax Number:
253-661-9190
Provider Enumeration Date:
10/16/2006