Provider First Line Business Practice Location Address:
210 GOVERNMENT RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTAWA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-929-1519
Provider Business Practice Location Address Fax Number:
509-932-5363
Provider Enumeration Date:
10/14/2008