Provider First Line Business Practice Location Address:
110 W CRAWFORD ST STE F
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-276-5644
Provider Business Practice Location Address Fax Number:
509-780-4394
Provider Enumeration Date:
10/03/2006