Provider First Line Business Practice Location Address:
4204 S CHAPMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENACRES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99016-8731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-230-5670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007