Provider First Line Business Practice Location Address:
13212 NE 138TH 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:
98034-5519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-813-0577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2026