Provider First Line Business Practice Location Address:
31408 28TH 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:
98023-7837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-335-7736
Provider Business Practice Location Address Fax Number:
253-235-5787
Provider Enumeration Date:
09/19/2025