Provider First Line Business Practice Location Address:
24925 132ND PL SE
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:
98042-6662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-422-6855
Provider Business Practice Location Address Fax Number:
253-277-2873
Provider Enumeration Date:
03/30/2026