Provider First Line Business Practice Location Address:
1221 S HAYFORD RD
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:
99244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-459-0619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2007