Provider First Line Business Practice Location Address:
10530 NE 119TH PL
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:
98034-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-591-1063
Provider Business Practice Location Address Fax Number:
425-242-7485
Provider Enumeration Date:
05/16/2025