Provider First Line Business Practice Location Address:
720 S 348TH ST
Provider Second Line Business Practice Location Address:
#A1-A
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-517-9065
Provider Business Practice Location Address Fax Number:
253-251-1938
Provider Enumeration Date:
12/27/2006