Provider First Line Business Practice Location Address:
165 NE KAMIAKEN ST 226
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-9916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-596-8118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2015