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24920 104th Ave Se Kent WA 98030-6443 | |
| (253) 395-2000 | |
| (253) 395-1956 |
| Full Name | |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 24920 104th Ave Se, Kent, Washington |
| Authorized Official Name and Position | Melissa Farley (TECHNICAL COORDINATOR) |
| Authorized Official Contact | 4259176282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3600 Lind Ave Sw Suite 100 Renton WA 98055-4934 Ph: (425) 656-5412 | 24920 104th Ave Se Kent WA 98030-6443 Ph: (253) 395-2000 |
| NPI Number | 1376590026 |
|---|---|
| Provider Enumeration Date | 05/28/2006 |
| Last Update Date | 01/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376590026 | NPI | - | NPPES |
| 7060353 | Medicaid | WA |
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