Provider First Line Business Practice Location Address:
15020 NE 193RD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUSH PRAIRIE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98606-3919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-812-9273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2026