Provider First Line Business Practice Location Address:
#70 ESTES AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SALMON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-490-7045
Provider Business Practice Location Address Fax Number:
805-544-1412
Provider Enumeration Date:
05/02/2008