Provider First Line Business Practice Location Address:
9212 N ELLENWOOD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINE MILE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99026-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-990-6595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2014