Provider First Line Business Practice Location Address:
411 N. 3RD ST.
Provider Second Line Business Practice Location Address:
SUITE A3
Provider Business Practice Location Address City Name:
ELMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-861-8184
Provider Business Practice Location Address Fax Number:
360-482-3527
Provider Enumeration Date:
01/12/2007