Provider First Line Business Practice Location Address:
6617 S 193RD PL
Provider Second Line Business Practice Location Address:
SUITE P-105
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-2197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-246-7421
Provider Business Practice Location Address Fax Number:
253-246-7427
Provider Enumeration Date:
06/26/2013