Provider First Line Business Practice Location Address:
12402 OSPREY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINE MILE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99026-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-488-3500
Provider Business Practice Location Address Fax Number:
509-488-3600
Provider Enumeration Date:
09/10/2019