Provider First Line Business Practice Location Address:
7705 DEAN ST W
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:
98499-7913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-346-8620
Provider Business Practice Location Address Fax Number:
253-301-1730
Provider Enumeration Date:
10/08/2025