Provider First Line Business Practice Location Address:
101 FIRST AVE S
Provider Second Line Business Practice Location Address:
ILWACO PHARMACY
Provider Business Practice Location Address City Name:
ILWACO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-642-4802
Provider Business Practice Location Address Fax Number:
360-642-5133
Provider Enumeration Date:
10/13/2006