Provider First Line Business Practice Location Address:
SE 100 CRESTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-636-3145
Provider Business Practice Location Address Fax Number:
509-636-3150
Provider Enumeration Date:
08/29/2006