Provider First Line Business Practice Location Address:
5708 198TH ST SW APT E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-802-8955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2026