Provider First Line Business Practice Location Address:
16521 13TH AVE W STE 107
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:
98037-8530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-780-9086
Provider Business Practice Location Address Fax Number:
425-599-1984
Provider Enumeration Date:
10/22/2025