Provider First Line Business Practice Location Address:
315 E CRAWFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99006-5338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-467-4500
Provider Business Practice Location Address Fax Number:
509-467-6032
Provider Enumeration Date:
01/23/2018