Provider First Line Business Practice Location Address:
5626 NE 200TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-817-5367
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2023