Provider First Line Business Practice Location Address:
202 S 348TH ST STE 2
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:
206-846-4805
Provider Business Practice Location Address Fax Number:
253-831-4880
Provider Enumeration Date:
08/13/2012