Provider First Line Business Practice Location Address:
3950 SW 324TH ST
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:
98023-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-5667
Provider Business Practice Location Address Fax Number:
253-874-1229
Provider Enumeration Date:
07/11/2005