Provider First Line Business Practice Location Address:
105 NORTH 2ND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99173-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-258-7543
Provider Business Practice Location Address Fax Number:
509-258-7524
Provider Enumeration Date:
12/07/2006