Provider First Line Business Practice Location Address:
3801 E FARWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEAD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99021-9605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-4602
Provider Business Practice Location Address Fax Number:
509-466-4698
Provider Enumeration Date:
11/26/2025