Provider First Line Business Practice Location Address:
227 E MIDWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLBERT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99005-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-443-5033
Provider Business Practice Location Address Fax Number:
509-443-5025
Provider Enumeration Date:
02/12/2019