Provider First Line Business Practice Location Address:
1401 S 320TH ST STE G
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-719-8554
Provider Business Practice Location Address Fax Number:
253-719-8673
Provider Enumeration Date:
04/11/2012