Provider First Line Business Practice Location Address:
1201 W. 5TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-671-2817
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2012