Provider First Line Business Practice Location Address:
728 S 320TH ST STE F
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:
98003-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-3937
Provider Business Practice Location Address Fax Number:
253-941-3935
Provider Enumeration Date:
04/26/2012