Provider First Line Business Practice Location Address:
7925 182ND PL SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-246-8857
Provider Business Practice Location Address Fax Number:
800-776-6694
Provider Enumeration Date:
01/09/2026