Provider First Line Business Practice Location Address:
11919 W SPRAGUE 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:
99001-1899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-244-6838
Provider Business Practice Location Address Fax Number:
509-244-6795
Provider Enumeration Date:
10/26/2005