Provider First Line Business Practice Location Address:
N. 115 CROSBY ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEKOA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99033-0629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-284-2423
Provider Business Practice Location Address Fax Number:
509-284-3434
Provider Enumeration Date:
04/20/2010