Provider First Line Business Practice Location Address:
15701 E SPRAGUE AVE
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
VERADALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-922-4809
Provider Business Practice Location Address Fax Number:
509-922-8718
Provider Enumeration Date:
07/01/2006