Provider First Line Business Practice Location Address:
124 OLD AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRAGUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99032-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-257-2926
Provider Business Practice Location Address Fax Number:
509-257-2865
Provider Enumeration Date:
05/17/2007