Provider First Line Business Practice Location Address:
810 NORTH THIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARFIELD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-635-1331
Provider Business Practice Location Address Fax Number:
509-635-1332
Provider Enumeration Date:
10/10/2006