Provider First Line Business Practice Location Address:
13210 SE 240TH ST
Provider Second Line Business Practice Location Address:
A6
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-5182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-854-9570
Provider Business Practice Location Address Fax Number:
253-854-3478
Provider Enumeration Date:
02/01/2007