Provider First Line Business Practice Location Address:
14120 N NEWPORT HWY
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
MEAD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99021-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-468-4861
Provider Business Practice Location Address Fax Number:
509-468-2101
Provider Enumeration Date:
12/22/2005