Provider First Line Business Practice Location Address:
1200 WEST FAIRVIEW AVENUE
Provider Second Line Business Practice Location Address:
BUILDING B
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:
509-397-9005
Provider Business Practice Location Address Fax Number:
509-397-2128
Provider Enumeration Date:
09/25/2006