Provider First Line Business Practice Location Address:
8417 E EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-407-8555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2016