Provider First Line Business Practice Location Address:
17 S WESTERN AVE STE 3
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:
98855-9270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-485-6585
Provider Business Practice Location Address Fax Number:
509-486-6586
Provider Enumeration Date:
01/31/2017