Provider First Line Business Practice Location Address:
1521 S. MULLEN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIRWAY HEIGHTS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-244-5549
Provider Business Practice Location Address Fax Number:
509-244-0749
Provider Enumeration Date:
06/21/2011