Provider First Line Business Practice Location Address:
HIGHWAY 25
Provider Second Line Business Practice Location Address:
TRIBAL HEALTH PROGRAM SANPOIL CLINIC
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99144-0414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-634-7325
Provider Business Practice Location Address Fax Number:
509-634-7326
Provider Enumeration Date:
02/28/2007