Provider First Line Business Practice Location Address:
48001 PRIOR AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-875-2029
Provider Business Practice Location Address Fax Number:
509-875-2310
Provider Enumeration Date:
04/19/2010