Provider First Line Business Practice Location Address:
206 W FIRST STREET
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-276-2844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007