Provider First Line Business Practice Location Address:
841 CENTRAL AVE N
Provider Second Line Business Practice Location Address:
SUITE C-215
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-867-5344
Provider Business Practice Location Address Fax Number:
253-867-5348
Provider Enumeration Date:
11/17/2011