Provider First Line Business Practice Location Address:
1646 SW DASH POINT RD
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:
98023-4566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-815-9560
Provider Business Practice Location Address Fax Number:
253-815-9580
Provider Enumeration Date:
04/13/2006