Provider First Line Business Practice Location Address:
10449 11TH 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:
98372-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-719-9422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2026