Provider First Line Business Practice Location Address:
14017 N NEWPORT HWY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
MEAD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-2252
Provider Business Practice Location Address Fax Number:
509-465-1669
Provider Enumeration Date:
08/25/2016