Provider First Line Business Practice Location Address:
1055 W FAIRVIEW ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLFAX
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99111-5106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-397-4077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2022