Provider First Line Business Practice Location Address:
PO BOX 37
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SALMON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98672-0037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-783-3090
Provider Business Practice Location Address Fax Number:
503-636-1284
Provider Enumeration Date:
05/07/2007