Provider First Line Business Practice Location Address:
2214 S 308TH 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:
98003-4823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-335-9983
Provider Business Practice Location Address Fax Number:
253-529-1214
Provider Enumeration Date:
02/14/2007