Provider First Line Business Practice Location Address:
66 NORTH 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMEROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99347-9705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-566-4141
Provider Business Practice Location Address Fax Number:
509-843-1234
Provider Enumeration Date:
10/10/2006