Provider First Line Business Practice Location Address:
13660 W. 6TH AVE.
Provider Second Line Business Practice Location Address:
APT I-106
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-342-8855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2022