Provider First Line Business Practice Location Address:
1025 S 320TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-839-4636
Provider Business Practice Location Address Fax Number:
253-946-8286
Provider Enumeration Date:
09/27/2006