Provider First Line Business Practice Location Address:
400 N MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLFAX
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99111-2035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-703-7177
Provider Business Practice Location Address Fax Number:
509-703-7177
Provider Enumeration Date:
10/20/2006