Provider First Line Business Practice Location Address:
1200 W FAIRVIEW 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:
99111-9552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-1770
Provider Business Practice Location Address Fax Number:
509-228-9542
Provider Enumeration Date:
08/30/2006