Provider First Line Business Practice Location Address:
18 EAST FOURTH STREET
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:
509-560-0080
Provider Business Practice Location Address Fax Number:
877-398-3107
Provider Enumeration Date:
11/15/2006