Provider First Line Business Practice Location Address:
1045 S 320TH 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:
98003-5179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-651-7920
Provider Business Practice Location Address Fax Number:
253-499-7988
Provider Enumeration Date:
02/28/2025