Provider First Line Business Practice Location Address:
2912 SW 333RD 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:
98023-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-293-6245
Provider Business Practice Location Address Fax Number:
253-392-2427
Provider Enumeration Date:
07/30/2025