Provider First Line Business Practice Location Address:
10618 SE KENT KANGLEY RD
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:
98030-9048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-859-5433
Provider Business Practice Location Address Fax Number:
253-859-4887
Provider Enumeration Date:
10/13/2010