Provider First Line Business Practice Location Address:
2511 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-845-8817
Provider Business Practice Location Address Fax Number:
253-845-6491
Provider Enumeration Date:
08/11/2006