Provider First Line Business Practice Location Address:
640 N MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SALMON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98672-8751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-493-2244
Provider Business Practice Location Address Fax Number:
509-493-2242
Provider Enumeration Date:
01/02/2007