Provider First Line Business Practice Location Address:
12824 W 12TH AVE
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:
99001-9408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-559-4600
Provider Business Practice Location Address Fax Number:
509-244-0906
Provider Enumeration Date:
12/16/2018