Provider First Line Business Practice Location Address:
13922 SE 86TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98059-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-718-5195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2025