Provider First Line Business Practice Location Address:
31460 13TH 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:
98023-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-765-1009
Provider Business Practice Location Address Fax Number:
253-409-2625
Provider Enumeration Date:
03/24/2026