Provider First Line Business Practice Location Address:
2222 MERIDIAN AVE E STE A
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:
98371-1032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-407-4171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2025