Provider First Line Business Practice Location Address:
940 N. CENTRAL
Provider Second Line Business Practice Location Address:
SUITE C
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:
253-854-3650
Provider Business Practice Location Address Fax Number:
253-854-0513
Provider Enumeration Date:
07/06/2006