Provider First Line Business Practice Location Address:
1181 THOMPSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COWICHE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98923-9758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-678-4343
Provider Business Practice Location Address Fax Number:
509-678-5494
Provider Enumeration Date:
08/31/2006