Provider First Line Business Practice Location Address:
405 WEST CALIFORNIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARFIELD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-635-1240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2007