Provider First Line Business Practice Location Address:
8405 NE 143RD 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:
98034-5062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-472-6167
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2026