Provider First Line Business Practice Location Address:
130352 STATE ROUTE 26
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:
99111-9635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-553-3850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2024