Provider First Line Business Practice Location Address:
1627 S 312TH ST
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-839-9330
Provider Business Practice Location Address Fax Number:
425-644-6067
Provider Enumeration Date:
11/19/2015