Provider First Line Business Practice Location Address:
12218 N GREENE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEAD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99021-7020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-844-2375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2026