Provider First Line Business Practice Location Address:
8004 NE 147TH LN
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:
98028-4762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-579-4574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2026