Provider First Line Business Practice Location Address:
1000 EAST JEWETT BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 201
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:
509-493-3220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2007