Provider First Line Business Practice Location Address:
214 N W DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBUR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-647-5821
Provider Business Practice Location Address Fax Number:
509-647-2047
Provider Enumeration Date:
10/31/2005