Provider First Line Business Practice Location Address:
1705 SOUTH 324TH PLACE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-6005
Provider Business Practice Location Address Fax Number:
253-661-6005
Provider Enumeration Date:
03/30/2007