Provider First Line Business Practice Location Address:
813 COLUMBIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMEROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99347-0099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-843-3495
Provider Business Practice Location Address Fax Number:
509-843-3496
Provider Enumeration Date:
01/23/2007