Provider First Line Business Practice Location Address:
926 S 348TH 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:
98003-7021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-924-0717
Provider Business Practice Location Address Fax Number:
253-925-1439
Provider Enumeration Date:
01/25/2007