Provider First Line Business Practice Location Address:
SOUTH 512 F STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRAGUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-257-2591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006