Provider First Line Business Practice Location Address:
203 S WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONASKET
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98855-8803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-486-2151
Provider Business Practice Location Address Fax Number:
509-486-3116
Provider Enumeration Date:
03/21/2007