Provider First Line Business Practice Location Address:
2455 W BENCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTHELLO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99344-8901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-989-2189
Provider Business Practice Location Address Fax Number:
509-488-3400
Provider Enumeration Date:
05/14/2013