Provider First Line Business Practice Location Address:
14500 JUANITA DR NE
Provider Second Line Business Practice Location Address:
BASTYR STUDENT VILLAGE
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-606-6105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2020