Provider First Line Business Practice Location Address:
220 E 3RD ST
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:
98855-8830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-557-9324
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2025