Provider First Line Business Practice Location Address:
625 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-758-6071
Provider Business Practice Location Address Fax Number:
509-758-6146
Provider Enumeration Date:
06/16/2005