Provider First Line Business Practice Location Address:
32241 24TH 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:
98023-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-0483
Provider Business Practice Location Address Fax Number:
253-563-3346
Provider Enumeration Date:
11/19/2025