Provider First Line Business Practice Location Address:
22210 NORTH GLADE RD 99343
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99343-0246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-269-4900
Provider Business Practice Location Address Fax Number:
509-269-4977
Provider Enumeration Date:
10/24/2012