Provider First Line Business Practice Location Address:
2119 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-758-3376
Provider Business Practice Location Address Fax Number:
509-758-3377
Provider Enumeration Date:
11/09/2006