Provider First Line Business Practice Location Address:
424 S 308TH 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:
98003-4025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-347-3745
Provider Business Practice Location Address Fax Number:
253-941-0908
Provider Enumeration Date:
10/07/2010