Provider First Line Business Practice Location Address:
184 ACADEMY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAITSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99361-0217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-337-6301
Provider Business Practice Location Address Fax Number:
509-337-6042
Provider Enumeration Date:
08/18/2006