Provider First Line Business Practice Location Address:
22416 88TH AVE S APT C106
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:
98031-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-294-3468
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2026