Provider First Line Business Practice Location Address:
1612 SW DASH POINT ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-835-5678
Provider Business Practice Location Address Fax Number:
253-835-7342
Provider Enumeration Date:
05/18/2006