Provider First Line Business Practice Location Address:
201 S 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98942-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-697-8500
Provider Business Practice Location Address Fax Number:
509-698-3510
Provider Enumeration Date:
11/21/2008