Provider First Line Business Practice Location Address:
34259 36TH PL 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:
98023-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-302-8490
Provider Business Practice Location Address Fax Number:
253-235-5780
Provider Enumeration Date:
04/27/2026