Provider First Line Business Practice Location Address:
12608 SE 215TH ST
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:
98031-2287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-981-4283
Provider Business Practice Location Address Fax Number:
253-478-3993
Provider Enumeration Date:
02/23/2026