Provider First Line Business Practice Location Address:
15010 W FOUR MOUND RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-468-1050
Provider Business Practice Location Address Fax Number:
509-252-0543
Provider Enumeration Date:
08/20/2017