Provider First Line Business Practice Location Address:
1014 SOUTH 320TH STREET
Provider Second Line Business Practice Location Address:
SUITE E
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:
253-529-0123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2009