Provider First Line Business Practice Location Address:
1415 SW 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:
98023-4521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-945-4819
Provider Business Practice Location Address Fax Number:
253-945-4848
Provider Enumeration Date:
09/11/2013