Provider First Line Business Practice Location Address:
3224 S SALTESE LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENACRES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99016-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-990-7441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2012