Provider First Line Business Practice Location Address:
1601 W MEEKER ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-4323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-8019
Provider Business Practice Location Address Fax Number:
253-480-2937
Provider Enumeration Date:
02/17/2012