Provider First Line Business Practice Location Address:
10110 W CHARLES 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:
99026-9624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-340-4304
Provider Business Practice Location Address Fax Number:
509-340-4301
Provider Enumeration Date:
07/10/2006