Provider First Line Business Practice Location Address:
116 N 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-482-6636
Provider Business Practice Location Address Fax Number:
360-482-6633
Provider Enumeration Date:
01/23/2006