Provider First Line Business Practice Location Address:
414 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99156-9077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-589-1678
Provider Business Practice Location Address Fax Number:
509-447-5310
Provider Enumeration Date:
08/16/2006