Provider First Line Business Practice Location Address:
13215 SE 240TH ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-5120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-631-3026
Provider Business Practice Location Address Fax Number:
253-631-3899
Provider Enumeration Date:
11/09/2006