Provider First Line Business Practice Location Address:
3013 S 363RD 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:
98003-7249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-991-8589
Provider Business Practice Location Address Fax Number:
253-835-5761
Provider Enumeration Date:
09/20/2005