Provider First Line Business Practice Location Address:
8641 NE 141ST ST
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:
98034-5328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-306-1697
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2026