Provider First Line Business Practice Location Address:
19 N 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHENEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99004-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-2531
Provider Business Practice Location Address Fax Number:
509-755-6580
Provider Enumeration Date:
09/18/2014