Provider First Line Business Practice Location Address:
23601 56TH AVE W UNIT 3101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-5265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
604-500-8114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2026