Provider First Line Business Practice Location Address:
12825 W SUSET HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIRWAY HEIGHTS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99001-9405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-244-5822
Provider Business Practice Location Address Fax Number:
502-244-3805
Provider Enumeration Date:
07/10/2006