Provider First Line Business Practice Location Address:
50 E SEATTLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98592-9617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-898-4871
Provider Business Practice Location Address Fax Number:
360-898-4870
Provider Enumeration Date:
12/28/2005