Provider First Line Business Practice Location Address:
14727 SE 145TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98059-7336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-644-4164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2026