Provider First Line Business Practice Location Address:
6700 NE 181ST ST UNIT 82130
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:
98028-4835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-386-5685
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2026