Provider First Line Business Practice Location Address:
13106 SE 240TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98031-9210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-854-9890
Provider Business Practice Location Address Fax Number:
253-852-0585
Provider Enumeration Date:
07/08/2005