Provider First Line Business Practice Location Address:
11313 8TH ST 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:
98372-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-517-1500
Provider Business Practice Location Address Fax Number:
253-517-1505
Provider Enumeration Date:
12/26/2012