Provider First Line Business Practice Location Address:
1125 MELLEN ST.
Provider Second Line Business Practice Location Address:
INNOVATION IN EYECARE INC.
Provider Business Practice Location Address City Name:
CENTRALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-736-7385
Provider Business Practice Location Address Fax Number:
360-736-8568
Provider Enumeration Date:
07/10/2007