Provider First Line Business Practice Location Address:
4130 A GARDEN SPOT RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOON LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-233-8660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008