Provider First Line Business Practice Location Address:
4040 NE 196TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155-2864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-275-2559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2024