Provider First Line Business Practice Location Address:
23830 PACIFIC HWY S
Provider Second Line Business Practice Location Address:
SUITE 102A
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-856-7574
Provider Business Practice Location Address Fax Number:
206-932-5221
Provider Enumeration Date:
12/26/2006