Provider First Line Business Practice Location Address:
13516 186TH STREET CT E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98374-6015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-489-7520
Provider Business Practice Location Address Fax Number:
360-872-0618
Provider Enumeration Date:
05/27/2026