Provider First Line Business Practice Location Address:
2800 SW 320TH STREET
Provider Second Line Business Practice Location Address:
DECATUR HIGH SCHOOL
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:
253-945-5243
Provider Business Practice Location Address Fax Number:
253-945-2177
Provider Enumeration Date:
10/23/2012