Provider First Line Business Practice Location Address:
103 N 1ST STREET
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:
360-482-5155
Provider Business Practice Location Address Fax Number:
360-482-4155
Provider Enumeration Date:
02/12/2007