Provider First Line Business Practice Location Address:
6624 SE 196TH ST
Provider Second Line Business Practice Location Address:
SUITE U-101
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-251-6955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008