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12511 Meridian E Puyallup WA 98373-3425 | |
(253) 848-8988 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 12511 Meridian E, Puyallup, Washington |
Authorized Official Name and Position | Edward M Kosnoski (OWNER) |
Authorized Official Contact | 2538522020 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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10002 Se 240th St Kent WA 98031-4839 Ph: (253) 852-2020 | 12511 Meridian E Puyallup WA 98373-3425 Ph: (253) 848-8988 |
NPI Number | 1760757850 |
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Provider Enumeration Date | 03/21/2012 |
Last Update Date | 03/21/2012 |
Identifier | Type | State | Issuer |
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1760757850 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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