Provider First Line Business Practice Location Address:
206 W MAIN ST
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99328-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-382-4281
Provider Business Practice Location Address Fax Number:
509-382-2845
Provider Enumeration Date:
01/08/2006