Provider First Line Business Practice Location Address:
9 E 1ST AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98942-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-697-4838
Provider Business Practice Location Address Fax Number:
509-697-6132
Provider Enumeration Date:
07/16/2006