Provider First Line Business Practice Location Address:
214 N GLOVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWISP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98856-0503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-341-4256
Provider Business Practice Location Address Fax Number:
253-231-5763
Provider Enumeration Date:
10/28/2008