Provider First Line Business Practice Location Address:
728 S 320TH ST
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-6365
Provider Business Practice Location Address Fax Number:
253-941-9166
Provider Enumeration Date:
08/17/2006