Provider First Line Business Practice Location Address:
502 E. BOONE AVE
Provider Second Line Business Practice Location Address:
AD 25
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-0025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-313-3848
Provider Business Practice Location Address Fax Number:
509-313-5964
Provider Enumeration Date:
01/03/2007