Provider First Line Business Practice Location Address:
32219 23RD AVE SW
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:
98023-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-927-0992
Provider Business Practice Location Address Fax Number:
253-927-0474
Provider Enumeration Date:
06/20/2025