Provider First Line Business Practice Location Address:
204 S MAIN 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:
99111-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-397-2951
Provider Business Practice Location Address Fax Number:
509-397-6772
Provider Enumeration Date:
12/03/2018