Provider First Line Business Practice Location Address:
10414 WEST HIGHWAY 2
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
AIRWAY HEIGHTS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-342-3380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2022