Provider First Line Business Practice Location Address:
101 CAMELIA ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL CITY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-346-1447
Provider Business Practice Location Address Fax Number:
509-346-1481
Provider Enumeration Date:
10/24/2006