Provider First Line Business Practice Location Address:
1209 S 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:
98003-5339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-1222
Provider Business Practice Location Address Fax Number:
253-945-7138
Provider Enumeration Date:
06/14/2006