Provider First Line Business Practice Location Address:
10056 SE 240TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98031-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-520-5611
Provider Business Practice Location Address Fax Number:
253-850-2982
Provider Enumeration Date:
12/27/2006