Provider First Line Business Practice Location Address:
8608 NE 140TH 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:
98034-5323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-522-5058
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2025