Provider First Line Business Practice Location Address:
SOUTH 310 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMIRA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99103-0217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-639-2414
Provider Business Practice Location Address Fax Number:
509-639-2620
Provider Enumeration Date:
07/02/2006