Provider First Line Business Practice Location Address:
5020 N MERRIE ST
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:
99025-9667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-590-7194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2014