Provider First Line Business Practice Location Address:
19 W. 1ST AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99159-0189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-982-2541
Provider Business Practice Location Address Fax Number:
509-982-2660
Provider Enumeration Date:
03/02/2007