Provider First Line Business Practice Location Address:
3418 90TH ST S APT 29
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-3681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-298-2187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2026