Provider First Line Business Practice Location Address:
27320 PACIFIC HWY S
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:
98003-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-529-7825
Provider Business Practice Location Address Fax Number:
253-528-0851
Provider Enumeration Date:
10/22/2015