Provider First Line Business Practice Location Address:
410 E JEWETT BLVD
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:
98672-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-493-4000
Provider Business Practice Location Address Fax Number:
509-493-1462
Provider Enumeration Date:
05/25/2010