Provider First Line Business Practice Location Address:
105 N. 2ND STREET
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
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:
11/16/2009