Provider First Line Business Practice Location Address:
1706 S 320TH ST STE E
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:
98003-5424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-839-4048
Provider Business Practice Location Address Fax Number:
253-839-4046
Provider Enumeration Date:
06/29/2006