Provider First Line Business Practice Location Address:
118 N. WHITCOMB AVE
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:
98855-9885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-486-3191
Provider Business Practice Location Address Fax Number:
509-486-4204
Provider Enumeration Date:
12/03/2019