Provider First Line Business Practice Location Address:
2431 E CANTER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99006-8167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-398-0401
Provider Business Practice Location Address Fax Number:
509-356-5709
Provider Enumeration Date:
02/27/2026