Provider First Line Business Practice Location Address:
1150 W FAIRVIEW 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:
99111-9580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-401-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2021