Provider First Line Business Practice Location Address:
503 S GOOD SAMARITAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99012-9677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-283-2118
Provider Business Practice Location Address Fax Number:
509-283-2359
Provider Enumeration Date:
11/09/2005