Provider First Line Business Practice Location Address:
8703 138TH AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98059-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-000-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2026