Provider First Line Business Practice Location Address:
7TH & KEASEY ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-365-2191
Provider Business Practice Location Address Fax Number:
509-369-3422
Provider Enumeration Date:
12/05/2006