Provider First Line Business Practice Location Address:
15628 N FREYA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEAD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99021-9342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-3623
Provider Business Practice Location Address Fax Number:
509-535-8413
Provider Enumeration Date:
10/13/2011