Provider First Line Business Practice Location Address:
805 S 309TH PL
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:
98003-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-941-3293
Provider Business Practice Location Address Fax Number:
253-941-3293
Provider Enumeration Date:
03/19/2008