Provider First Line Business Practice Location Address:
1109 S 348TH ST
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:
98003-7079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-944-1848
Provider Business Practice Location Address Fax Number:
253-944-1857
Provider Enumeration Date:
11/15/2012