Provider First Line Business Practice Location Address:
2122 SW 336TH 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:
98023-2883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-927-7777
Provider Business Practice Location Address Fax Number:
253-927-6319
Provider Enumeration Date:
10/05/2006