Provider First Line Business Practice Location Address:
18504 61ST PL NE
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:
98028-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-830-7168
Provider Business Practice Location Address Fax Number:
425-949-5064
Provider Enumeration Date:
03/14/2025