Provider First Line Business Practice Location Address:
210 S MAIN 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:
99111-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-394-4611
Provider Business Practice Location Address Fax Number:
509-397-2917
Provider Enumeration Date:
06/22/2007