Provider First Line Business Practice Location Address:
8779 W MILLSAP LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHENEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99004-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-397-7134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2026