Provider First Line Business Practice Location Address:
1867 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:
99004-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-3937
Provider Business Practice Location Address Fax Number:
509-453-6567
Provider Enumeration Date:
11/02/2006