Provider First Line Business Practice Location Address:
801 S 336TH 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:
98003-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-874-5319
Provider Business Practice Location Address Fax Number:
253-838-5586
Provider Enumeration Date:
03/28/2008