Provider First Line Business Practice Location Address:
20518 108TH AVENUE SOUTHEAST
Provider Second Line Business Practice Location Address:
PANTHER LAKE
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98031-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-854-2999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006