Provider First Line Business Practice Location Address:
5928 HIGHWAY 291
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINE MILE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99026-9525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-5663
Provider Business Practice Location Address Fax Number:
509-467-8663
Provider Enumeration Date:
05/11/2006