Provider First Line Business Practice Location Address:
20030 SE 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAMMAMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98074-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-939-9230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2026