Provider First Line Business Practice Location Address:
1004 W JAMES ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-852-3194
Provider Business Practice Location Address Fax Number:
253-852-2884
Provider Enumeration Date:
09/25/2006