Provider First Line Business Practice Location Address:
524 W MEEKER ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-5766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-850-9973
Provider Business Practice Location Address Fax Number:
253-850-1405
Provider Enumeration Date:
01/13/2007