Provider First Line Business Practice Location Address:
14400 NE 145TH ST STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072-7102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-764-1142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2026