Provider First Line Business Practice Location Address:
4304 N. MURRAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTIS ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-226-4304
Provider Business Practice Location Address Fax Number:
509-226-3304
Provider Enumeration Date:
12/21/2006