Provider First Line Business Practice Location Address:
117 FIFTH STREET ALLEY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSLYN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98941-0441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-649-3137
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2013