Provider First Line Business Practice Location Address:
221 2ND AVE S
Provider Second Line Business Practice Location Address:
SUITE # 103
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-5873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-852-5155
Provider Business Practice Location Address Fax Number:
253-852-5159
Provider Enumeration Date:
11/02/2006