Provider First Line Business Practice Location Address:
614 CANYON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWISP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-997-7062
Provider Business Practice Location Address Fax Number:
509-997-7022
Provider Enumeration Date:
01/31/2007