Provider First Line Business Practice Location Address:
827 W VALLEY HWY
Provider Second Line Business Practice Location Address:
TRLR #50
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-584-0412
Provider Business Practice Location Address Fax Number:
253-277-0765
Provider Enumeration Date:
11/03/2008