Provider First Line Business Practice Location Address:
315 S. 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:
509-486-0123
Provider Business Practice Location Address Fax Number:
509-486-0124
Provider Enumeration Date:
02/08/2019