Provider First Line Business Practice Location Address:
21 COLVILLE ST.
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:
509-634-2586
Provider Business Practice Location Address Fax Number:
509-634-2607
Provider Enumeration Date:
04/14/2009