Provider First Line Business Practice Location Address:
1045 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:
98003-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-2273
Provider Business Practice Location Address Fax Number:
253-946-1596
Provider Enumeration Date:
05/25/2006