Provider First Line Business Practice Location Address:
29818 S NORTH PINE CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPANGLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99031-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-245-3223
Provider Business Practice Location Address Fax Number:
509-245-3288
Provider Enumeration Date:
07/09/2006