Provider First Line Business Practice Location Address:
3217 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:
253-927-5905
Provider Business Practice Location Address Fax Number:
253-321-0219
Provider Enumeration Date:
06/24/2007