Provider First Line Business Practice Location Address:
420 W SMITH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-867-1616
Provider Business Practice Location Address Fax Number:
253-867-1618
Provider Enumeration Date:
07/29/2009