Provider First Line Business Practice Location Address:
109 S MAIN 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:
99111-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-397-2111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2022