Provider First Line Business Practice Location Address:
1206 S 244TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-4986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-429-2275
Provider Business Practice Location Address Fax Number:
206-429-2257
Provider Enumeration Date:
05/19/2026