Provider First Line Business Practice Location Address:
400 BURDIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND COULEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-633-0861
Provider Business Practice Location Address Fax Number:
509-633-0865
Provider Enumeration Date:
04/18/2008