Provider First Line Business Practice Location Address:
110 SOUTH ALDER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-739-2851
Provider Business Practice Location Address Fax Number:
360-691-7264
Provider Enumeration Date:
06/09/2008