Provider First Line Business Practice Location Address:
5606 N MARTINSON RD
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:
99025-8482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-723-3723
Provider Business Practice Location Address Fax Number:
513-982-0437
Provider Enumeration Date:
02/10/2021