Provider First Line Business Practice Location Address:
13003 SE KENT KANGLEY RD
Provider Second Line Business Practice Location Address:
SUITE #109
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98030-7919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-630-8686
Provider Business Practice Location Address Fax Number:
253-630-0188
Provider Enumeration Date:
05/23/2007