Provider First Line Business Practice Location Address:
11919 W SPRAGUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIRWAY HEIGHTS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99001-5295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-220-6926
Provider Business Practice Location Address Fax Number:
509-220-6926
Provider Enumeration Date:
11/19/2025