Provider First Line Business Practice Location Address:
610 WEST SECOND ST.
Provider Second Line Business Practice Location Address:
BOX 849
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-447-3105
Provider Business Practice Location Address Fax Number:
509-447-5661
Provider Enumeration Date:
09/01/2016