Provider First Line Business Practice Location Address:
530 S 336TH ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-3857
Provider Business Practice Location Address Fax Number:
253-661-4007
Provider Enumeration Date:
06/13/2014