Provider First Line Business Practice Location Address:
5524 189TH 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:
98036-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-306-3174
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2026