Provider First Line Business Practice Location Address:
1640 S 318TH PL
Provider Second Line Business Practice Location Address:
#D
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-886-2788
Provider Business Practice Location Address Fax Number:
253-945-0501
Provider Enumeration Date:
11/04/2009