Provider First Line Business Practice Location Address:
2335 SW 320TH ST
Provider Second Line Business Practice Location Address:
STE.2
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98023-2569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-9715
Provider Business Practice Location Address Fax Number:
253-838-7009
Provider Enumeration Date:
11/13/2006