Provider First Line Business Practice Location Address:
10868 W SAGEWOOD RD
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:
99026-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-217-4606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2021