Provider First Line Business Practice Location Address:
13218 W. SUNSET HWY
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:
90001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-263-7347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2008