Provider First Line Business Practice Location Address:
19 - 4TH STREET W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONASKET
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-322-4128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2012