Provider First Line Business Practice Location Address:
2201 SW 356TH 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:
98023-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-1441
Provider Business Practice Location Address Fax Number:
253-838-4345
Provider Enumeration Date:
09/30/2010