Provider First Line Business Practice Location Address:
26102 147TH PL SE
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:
98042-8144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-421-2212
Provider Business Practice Location Address Fax Number:
253-322-0499
Provider Enumeration Date:
04/13/2026