Provider First Line Business Practice Location Address:
1600 W JAMES PL APT 2A05
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:
98032-4335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-758-1222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2025