Provider First Line Business Practice Location Address:
12404 S. CARTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEYFORD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-979-1926
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2005