Provider First Line Business Practice Location Address:
13210 SE 240TH ST
Provider Second Line Business Practice Location Address:
SUITE B1
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-5182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-631-8490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2012