Provider First Line Business Practice Location Address:
10725 SE 256TH STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-520-3820
Provider Business Practice Location Address Fax Number:
253-852-0755
Provider Enumeration Date:
12/28/2006