Provider First Line Business Practice Location Address:
506 HARRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98942-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-823-5382
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2008