Provider First Line Business Practice Location Address:
22605 SE 56TH ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98029-5297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-369-1533
Provider Business Practice Location Address Fax Number:
425-369-1533
Provider Enumeration Date:
01/22/2026