Provider First Line Business Practice Location Address:
6047 NE 203RD ST KENMORE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-8530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-816-5252
Provider Business Practice Location Address Fax Number:
206-816-5252
Provider Enumeration Date:
06/19/2026