Provider First Line Business Practice Location Address:
2335 SW 320TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98023-2569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-2222
Provider Business Practice Location Address Fax Number:
253-661-1544
Provider Enumeration Date:
11/22/2005