Provider First Line Business Practice Location Address:
221 W. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98541-0577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-482-2442
Provider Business Practice Location Address Fax Number:
360-482-4688
Provider Enumeration Date:
12/14/2006