Provider First Line Business Practice Location Address:
2450 S STAR LAKE RD
Provider Second Line Business Practice Location Address:
MARK TWAIN ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-945-3137
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2014