Provider First Line Business Practice Location Address:
616 1/2 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-486-2991
Provider Business Practice Location Address Fax Number:
509-486-2992
Provider Enumeration Date:
12/17/2010