Provider First Line Business Practice Location Address:
2317 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:
98023-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-927-6411
Provider Business Practice Location Address Fax Number:
253-661-1564
Provider Enumeration Date:
01/31/2007