Provider First Line Business Practice Location Address:
2702 N ARGONNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-892-1637
Provider Business Practice Location Address Fax Number:
509-892-3726
Provider Enumeration Date:
10/07/2011