Provider First Line Business Practice Location Address:
12819 120TH AVE NE STE I
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:
98034-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-803-0400
Provider Business Practice Location Address Fax Number:
425-803-3368
Provider Enumeration Date:
03/30/2026