Provider First Line Business Practice Location Address:
809 W MAIN ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
POMEROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-566-7082
Provider Business Practice Location Address Fax Number:
509-418-0782
Provider Enumeration Date:
09/02/2025