Provider First Line Business Practice Location Address:
700 S 320TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-4691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-839-6550
Provider Business Practice Location Address Fax Number:
503-362-8435
Provider Enumeration Date:
10/11/2013