Provider First Line Business Practice Location Address:
2319 SW 320TH ST
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:
98023-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-8733
Provider Business Practice Location Address Fax Number:
253-927-6911
Provider Enumeration Date:
04/06/2007