Provider First Line Business Practice Location Address:
25248 PACIFIC HWY S
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-5766
Provider Business Practice Location Address Fax Number:
253-946-5771
Provider Enumeration Date:
12/31/2014