Provider First Line Business Practice Location Address:
2530 62ND AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIFE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98424-2294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-433-1448
Provider Business Practice Location Address Fax Number:
253-433-1448
Provider Enumeration Date:
07/18/2026