Provider First Line Business Practice Location Address:
8009 SO 180TH ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-282-0406
Provider Business Practice Location Address Fax Number:
425-282-0404
Provider Enumeration Date:
11/22/2006