Provider First Line Business Practice Location Address:
29717 225TH PL SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACK DIAMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98010-1276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-263-5970
Provider Business Practice Location Address Fax Number:
253-735-6705
Provider Enumeration Date:
06/29/2026