Provider First Line Business Practice Location Address:
30611 16TH AVE S
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:
98003-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-945-2627
Provider Business Practice Location Address Fax Number:
253-945-2626
Provider Enumeration Date:
12/03/2012