Provider First Line Business Practice Location Address:
8009 S 180TH ST STE 103
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:
98032-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-248-6462
Provider Business Practice Location Address Fax Number:
253-340-1008
Provider Enumeration Date:
03/25/2026