Provider First Line Business Practice Location Address:
13210 SE 240TH ST. SUITE B-1
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:
98042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-631-8490
Provider Business Practice Location Address Fax Number:
253-639-3929
Provider Enumeration Date:
10/27/2006