Provider First Line Business Practice Location Address:
214 SW MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBUR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-647-5321
Provider Business Practice Location Address Fax Number:
509-647-2238
Provider Enumeration Date:
06/15/2006