Provider First Line Business Practice Location Address:
728 S 320TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-9968
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2008