Provider First Line Business Practice Location Address:
425 E 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAITSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99361-9742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-540-7208
Provider Business Practice Location Address Fax Number:
509-351-2043
Provider Enumeration Date:
11/27/2013