Provider First Line Business Practice Location Address:
661 SOUTH COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99326-0077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-234-0866
Provider Business Practice Location Address Fax Number:
509-234-0818
Provider Enumeration Date:
03/01/2007