Provider First Line Business Practice Location Address:
1011 N PARK 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:
99111-2124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-397-4917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2012