Provider First Line Business Practice Location Address:
820 S SCHUSTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDENDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98620-9038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-773-6831
Provider Business Practice Location Address Fax Number:
509-773-5463
Provider Enumeration Date:
06/27/2006