Provider First Line Business Practice Location Address:
6212 N CHASE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWMAN LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99025-8657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-226-0529
Provider Business Practice Location Address Fax Number:
509-621-0322
Provider Enumeration Date:
12/30/2014