Provider First Line Business Practice Location Address:
435 W WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99156-9033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-935-6004
Provider Business Practice Location Address Fax Number:
509-935-4196
Provider Enumeration Date:
08/06/2007