Provider First Line Business Practice Location Address:
211 EUCLID ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98930-1160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-882-1331
Provider Business Practice Location Address Fax Number:
509-882-2850
Provider Enumeration Date:
02/14/2013