Provider First Line Business Practice Location Address:
AGENCY CAMPUS HWY 155
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NESPELEM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-634-2914
Provider Business Practice Location Address Fax Number:
509-634-2954
Provider Enumeration Date:
03/06/2007