Provider First Line Business Practice Location Address:
1010 N MORTON ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-844-8774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2009