Provider First Line Business Practice Location Address:
6410 NE 182ND ST
Provider Second Line Business Practice Location Address:
COTTAGE
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-676-4610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2026