Provider First Line Business Practice Location Address:
765 PRESTON AVE
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:
99361-7723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-337-6149
Provider Business Practice Location Address Fax Number:
509-337-6220
Provider Enumeration Date:
11/30/2005