Provider First Line Business Practice Location Address:
19625 62ND AVE S
Provider Second Line Business Practice Location Address:
SUITE A 101
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-852-5612
Provider Business Practice Location Address Fax Number:
253-852-0427
Provider Enumeration Date:
04/21/2006