Provider First Line Business Practice Location Address:
21628 SE 239TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98038-8571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-343-4950
Provider Business Practice Location Address Fax Number:
360-443-7570
Provider Enumeration Date:
05/15/2007