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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-842-7297
Provider Business Practice Location Address Fax Number:
509-455-4988
Provider Enumeration Date:
08/30/2022