Provider First Line Business Practice Location Address:
31113 N CHIPMONK RD
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:
99003-9611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-368-1038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2025