Provider First Line Business Practice Location Address:
1658 N 145TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-954-2733
Provider Business Practice Location Address Fax Number:
206-366-1221
Provider Enumeration Date:
09/12/2025