Provider First Line Business Practice Location Address:
940 CENTRAL AVE N STE B
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:
98032-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-854-2004
Provider Business Practice Location Address Fax Number:
253-859-9379
Provider Enumeration Date:
03/24/2026