Provider First Line Business Practice Location Address:
1207 N MORTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLFAX
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99111-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-649-5160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2026