Provider First Line Business Practice Location Address:
3034 HUFFMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99181-9749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-937-2413
Provider Business Practice Location Address Fax Number:
509-937-2204
Provider Enumeration Date:
08/18/2006