Provider First Line Business Practice Location Address:
9814 W OWNBY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINE MILE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99026-9622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-869-4737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2011