Provider First Line Business Practice Location Address:
COYOTE RIDGE CORRECTION CENTER
Provider Second Line Business Practice Location Address:
1301 NORTH EPHRATA AVE.
Provider Business Practice Location Address City Name:
CONNELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-543-5921
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2018