Provider First Line Business Practice Location Address:
5004 188TH ST 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:
98037-5422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-631-0783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2026