Provider First Line Business Practice Location Address:
1707 S 341ST PL STE C
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:
98003-6867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-3111
Provider Business Practice Location Address Fax Number:
253-838-3674
Provider Enumeration Date:
07/10/2010