Provider First Line Business Practice Location Address:
321 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:
99133-0680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-633-3260
Provider Business Practice Location Address Fax Number:
509-633-3212
Provider Enumeration Date:
10/14/2006