Provider First Line Business Practice Location Address:
23 EAST CRAWFORD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99006-0249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-276-8859
Provider Business Practice Location Address Fax Number:
509-276-1495
Provider Enumeration Date:
12/07/2011