Provider First Line Business Practice Location Address:
1717 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHENEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99004-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-235-6241
Provider Business Practice Location Address Fax Number:
509-235-6218
Provider Enumeration Date:
07/15/2009