Provider First Line Business Practice Location Address:
2784 MILKY WAY
Provider Second Line Business Practice Location Address:
NORTH COUNTRY ANESTHESIA
Provider Business Practice Location Address City Name:
CHEWELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99109-9538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-935-6225
Provider Business Practice Location Address Fax Number:
509-935-6207
Provider Enumeration Date:
12/13/2006