Provider First Line Business Practice Location Address:
235 MAIN STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-337-6311
Provider Business Practice Location Address Fax Number:
509-337-6011
Provider Enumeration Date:
10/17/2006