Provider First Line Business Practice Location Address:
600 E. MAIN STREET
Provider Second Line Business Practice Location Address:
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:
360-346-2222
Provider Business Practice Location Address Fax Number:
360-346-2161
Provider Enumeration Date:
05/27/2010