Provider First Line Business Practice Location Address:
1230 S 336TH
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:
98003-6386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-661-2344
Provider Business Practice Location Address Fax Number:
253-661-2539
Provider Enumeration Date:
01/08/2007