Provider First Line Business Practice Location Address:
11811 N WEST NEWMAN LAKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWMAN LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99025-8661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-228-8710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2010