Provider First Line Business Practice Location Address:
601 W GOWE 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:
98032-5745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-854-2028
Provider Business Practice Location Address Fax Number:
253-854-2744
Provider Enumeration Date:
11/30/2006