Provider First Line Business Practice Location Address:
64 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHLAMET
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-795-3242
Provider Business Practice Location Address Fax Number:
360-795-3145
Provider Enumeration Date:
05/15/2025