Provider First Line Business Practice Location Address:
700 SOUTH FIRST STREET
Provider Second Line Business Practice Location Address:
C/O SHELTON-MASON COUNTY COOP
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-426-2151
Provider Business Practice Location Address Fax Number:
360-426-9727
Provider Enumeration Date:
10/03/2006