Provider First Line Business Practice Location Address:
206 W 1ST ST
Provider Second Line Business Practice Location Address:
SUITE C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-312-4820
Provider Business Practice Location Address Fax Number:
509-931-0449
Provider Enumeration Date:
05/17/2023