Provider First Line Business Practice Location Address:
FIFTH & C STREETS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORIENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-6873
Provider Business Practice Location Address Fax Number:
509-684-3489
Provider Enumeration Date:
09/29/2006