Provider First Line Business Practice Location Address:
1706 S 320TH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-8000
Provider Business Practice Location Address Fax Number:
253-941-2420
Provider Enumeration Date:
11/14/2006