Provider First Line Business Practice Location Address:
2516 S 286TH PL APT C
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:
98003-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-910-3304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2026