Provider First Line Business Practice Location Address:
24102 S BOSTON RD
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:
99004-8958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-239-4590
Provider Business Practice Location Address Fax Number:
509-239-4591
Provider Enumeration Date:
02/08/2007