Provider First Line Business Practice Location Address:
1028 S 325TH 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:
98003-5933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-269-6108
Provider Business Practice Location Address Fax Number:
253-269-6108
Provider Enumeration Date:
03/16/2008