Provider First Line Business Practice Location Address:
2405 SOUTH 300TH
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-945-4430
Provider Business Practice Location Address Fax Number:
253-945-2177
Provider Enumeration Date:
10/23/2012