Provider First Line Business Practice Location Address:
310 N MAIN 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:
99111-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-397-6280
Provider Business Practice Location Address Fax Number:
509-397-6239
Provider Enumeration Date:
10/19/2006