Provider First Line Business Practice Location Address:
2308 S 288TH 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:
98003-7910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
125-356-9322
Provider Business Practice Location Address Fax Number:
253-269-7453
Provider Enumeration Date:
08/24/2013