Provider First Line Business Practice Location Address:
12901 SE KENT KANGLEY RD
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:
98030-7939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-630-1575
Provider Business Practice Location Address Fax Number:
253-630-4650
Provider Enumeration Date:
07/16/2009