Provider First Line Business Practice Location Address:
914 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-758-2936
Provider Business Practice Location Address Fax Number:
509-758-2488
Provider Enumeration Date:
02/01/2007