Provider First Line Business Practice Location Address:
35100 ENCHANTED PKWY S
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:
98003-8314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-3652
Provider Business Practice Location Address Fax Number:
253-874-4965
Provider Enumeration Date:
02/10/2015