Provider First Line Business Practice Location Address:
5952 BLACKSTONE WAY #100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINE MILE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-464-0002
Provider Business Practice Location Address Fax Number:
509-464-2378
Provider Enumeration Date:
04/20/2010