Provider First Line Business Practice Location Address:
300 JIM CLEMENT WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-834-7413
Provider Business Practice Location Address Fax Number:
509-494-8888
Provider Enumeration Date:
04/20/2026