Provider First Line Business Practice Location Address:
1332 PHAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99009-8669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-565-5962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2026