Provider First Line Business Practice Location Address:
1271 HIGHLAND AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99403-2846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-769-2201
Provider Business Practice Location Address Fax Number:
509-758-9199
Provider Enumeration Date:
09/14/2006