Provider First Line Business Practice Location Address:
20038 68TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-395-2630
Provider Business Practice Location Address Fax Number:
253-395-2634
Provider Enumeration Date:
05/09/2006