Provider First Line Business Practice Location Address:
530 S 336TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-5053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2006