Provider First Line Business Practice Location Address:
545 SE CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHTUCNA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-646-3290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006