Provider First Line Business Practice Location Address:
336 CAMELIA ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL CITY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99357-0220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-346-2658
Provider Business Practice Location Address Fax Number:
509-346-2129
Provider Enumeration Date:
10/10/2006