Provider First Line Business Practice Location Address:
481 METZGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-427-4030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006