Provider First Line Business Practice Location Address:
2122 SW 316TH 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:
98023-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-347-2225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2009