Provider First Line Business Practice Location Address:
601 GOVERNMENT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTAWA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99349-5120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-488-5256
Provider Business Practice Location Address Fax Number:
509-488-9939
Provider Enumeration Date:
07/27/2021