Provider First Line Business Practice Location Address:
66 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMEROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99347-9705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-843-1591
Provider Business Practice Location Address Fax Number:
509-843-1234
Provider Enumeration Date:
10/10/2006