Provider First Line Business Practice Location Address:
217 AIRPORT WAY SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESERT AIRE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99349-1973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-366-3733
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2007