Provider First Line Business Practice Location Address:
1119 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403-2836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-751-1110
Provider Business Practice Location Address Fax Number:
509-751-1114
Provider Enumeration Date:
10/23/2007