Provider First Line Business Practice Location Address:
1920 143RD 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:
98087-6088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-765-0480
Provider Business Practice Location Address Fax Number:
206-299-6532
Provider Enumeration Date:
08/10/2026