Provider First Line Business Practice Location Address:
51409 W PRYOR RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-875-2601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2006