Provider First Line Business Practice Location Address:
12611 NE 134TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-890-2206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2026