Provider First Line Business Practice Location Address:
1000 W STEUBEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BINGEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98605-9175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-493-1143
Provider Business Practice Location Address Fax Number:
877-644-1937
Provider Enumeration Date:
12/12/2006