Provider First Line Business Practice Location Address:
6632 S 191ST PL
Provider Second Line Business Practice Location Address:
SUITE E100
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98032-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-656-8811
Provider Business Practice Location Address Fax Number:
425-656-9015
Provider Enumeration Date:
01/11/2012