Provider First Line Business Practice Location Address:
35419 18TH AVE 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:
98023-6909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-488-4879
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2026