Provider First Line Business Practice Location Address:
17914 145TH PL NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072-9244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-795-3427
Provider Business Practice Location Address Fax Number:
206-795-3427
Provider Enumeration Date:
06/29/2026