Provider First Line Business Practice Location Address:
100 HAUSMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97327-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-552-1904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2021