Provider First Line Business Practice Location Address:
205 S OLD HWY 195
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPANGLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99031-9542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-362-2464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2026