Provider First Line Business Practice Location Address:
29613 20TH AVE S
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:
98003-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-349-1911
Provider Business Practice Location Address Fax Number:
206-349-1911
Provider Enumeration Date:
11/03/2025