Provider First Line Business Practice Location Address:
12721 W 14TH AVE
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:
99001-9409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-244-9948
Provider Business Practice Location Address Fax Number:
509-244-9914
Provider Enumeration Date:
05/30/2012