Provider First Line Business Practice Location Address:
1220 S 356TH ST STE C13
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:
98003-7479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-6528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006