Provider First Line Business Practice Location Address:
W. 13326 14TH STREET
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:
509-244-3655
Provider Business Practice Location Address Fax Number:
509-244-9527
Provider Enumeration Date:
03/29/2010