Provider First Line Business Practice Location Address:
1819 CENTRAL AVE S
Provider Second Line Business Practice Location Address:
SUITE 132
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-921-8812
Provider Business Practice Location Address Fax Number:
253-833-0480
Provider Enumeration Date:
01/23/2007