Provider First Line Business Practice Location Address:
242 SCHOOL HOUSE LOOP ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NESPELEM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99155-0511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-978-9115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2025