Provider First Line Business Practice Location Address:
34705 N NEWPORT HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTAROY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99003-7711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-292-2001
Provider Business Practice Location Address Fax Number:
509-292-9744
Provider Enumeration Date:
05/04/2006