Provider First Line Business Practice Location Address:
202 S 348TH ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-7070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-2353
Provider Business Practice Location Address Fax Number:
253-838-2972
Provider Enumeration Date:
01/22/2013