Provider First Line Business Practice Location Address:
720 S 348TH ST STE A-1B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-944-7620
Provider Business Practice Location Address Fax Number:
253-944-7621
Provider Enumeration Date:
03/14/2018