Provider First Line Business Practice Location Address:
125 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-794-4830
Provider Business Practice Location Address Fax Number:
360-793-6737
Provider Enumeration Date:
08/14/2006