Provider First Line Business Practice Location Address:
39 CLARKSON MILL RD
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:
509-322-0948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007