Provider First Line Business Practice Location Address:
3201 S 323RD 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:
98001-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-810-8895
Provider Business Practice Location Address Fax Number:
877-780-0122
Provider Enumeration Date:
08/02/2009