Provider First Line Business Practice Location Address:
934 S GARFIELD 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:
99001-9030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-789-7630
Provider Business Practice Location Address Fax Number:
509-445-0646
Provider Enumeration Date:
01/29/2013