Provider First Line Business Practice Location Address:
2100 S 285TH ST
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:
98003-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-455-2957
Provider Business Practice Location Address Fax Number:
253-322-0169
Provider Enumeration Date:
09/19/2023