Provider First Line Business Practice Location Address:
18 W. 1ST AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-982-2880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007