Provider First Line Business Practice Location Address:
17 SOUTH SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99140-0367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-634-4325
Provider Business Practice Location Address Fax Number:
509-634-4330
Provider Enumeration Date:
09/06/2006