Provider First Line Business Practice Location Address:
1819 CENTRAL AVE SO
Provider Second Line Business Practice Location Address:
SOUTH CENTRAL BLDG A STE 111
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-852-5503
Provider Business Practice Location Address Fax Number:
253-852-3612
Provider Enumeration Date:
02/12/2007