Provider First Line Business Practice Location Address:
1422 140TH PL SW
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:
98087-6051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-818-3439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2025