Provider First Line Business Practice Location Address:
112 RAIL ROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-674-2822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2008