Provider First Line Business Practice Location Address:
5919 HIGHWAY 291 STE 6
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:
99026-9007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-822-7084
Provider Business Practice Location Address Fax Number:
509-822-7279
Provider Enumeration Date:
11/22/2023