Provider First Line Business Practice Location Address:
4421 145TH PL 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:
98087-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-584-6966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2026