Provider First Line Business Practice Location Address:
2912 228TH AVE SE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAMMAMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98075-9305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-835-2514
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2026