Provider First Line Business Practice Location Address:
W 13011 SHORE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINE MILE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-991-5678
Provider Business Practice Location Address Fax Number:
509-328-7802
Provider Enumeration Date:
08/22/2006