Provider First Line Business Practice Location Address:
39 CLARKSON MILL ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-486-1616
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2010