Provider First Line Business Practice Location Address:
115 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98942-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-698-4327
Provider Business Practice Location Address Fax Number:
509-698-3382
Provider Enumeration Date:
04/01/2010