Provider First Line Business Practice Location Address:
18115 68TH AVE NE STE C104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
485-486-5033
Provider Business Practice Location Address Fax Number:
425-402-3788
Provider Enumeration Date:
05/02/2015