Provider First Line Business Practice Location Address:
19425 S DUNCAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPANGLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99031-9754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-245-3773
Provider Business Practice Location Address Fax Number:
509-245-3774
Provider Enumeration Date:
03/11/2007