Provider First Line Business Practice Location Address:
824 149TH ST SW UNIT B
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:
98087-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-444-5781
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2026