Provider First Line Business Practice Location Address:
132 AMES RD
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:
98942-9486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-969-4245
Provider Business Practice Location Address Fax Number:
509-966-5731
Provider Enumeration Date:
10/25/2006