Provider First Line Business Practice Location Address:
20113 N HALLIDAY RD
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:
99021-7801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
287-486-6788
Provider Business Practice Location Address Fax Number:
509-238-6847
Provider Enumeration Date:
04/25/2014