Provider First Line Business Practice Location Address:
2000 SO 314TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-529-7168
Provider Business Practice Location Address Fax Number:
253-529-7237
Provider Enumeration Date:
10/26/2009