Provider First Line Business Practice Location Address:
313 S 330TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-202-2745
Provider Business Practice Location Address Fax Number:
253-835-6161
Provider Enumeration Date:
02/26/2013