Provider First Line Business Practice Location Address:
1625 MERIDIAN AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98371-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-592-3389
Provider Business Practice Location Address Fax Number:
253-538-1616
Provider Enumeration Date:
09/27/2006