Provider First Line Business Practice Location Address:
5978 HIGHWAY 291 STE 2
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:
99026-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-934-1981
Provider Business Practice Location Address Fax Number:
509-381-5925
Provider Enumeration Date:
08/31/2022