Provider First Line Business Practice Location Address: 
12040 NE 128TH ST
    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: 
98034-3013
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
425-899-3200
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/25/2023