Provider First Line Business Practice Location Address:
812 SW 296TH 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:
98023-8250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-902-6817
Provider Business Practice Location Address Fax Number:
360-902-4249
Provider Enumeration Date:
02/27/2006