Provider First Line Business Practice Location Address:
2319 SW 320TH 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:
98023-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-683-8167
Provider Business Practice Location Address Fax Number:
206-420-0366
Provider Enumeration Date:
02/09/2010