Provider First Line Business Practice Location Address:
5919 HIGHWAY 291 STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINE MILE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99026-9525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-935-8611
Provider Business Practice Location Address Fax Number:
509-935-6983
Provider Enumeration Date:
07/07/2010