Provider First Line Business Practice Location Address:
22630 36TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98252-9348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-315-4435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2025