Provider First Line Business Practice Location Address:
2809 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:
98371-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-840-1100
Provider Business Practice Location Address Fax Number:
253-840-1199
Provider Enumeration Date:
03/27/2007