Provider First Line Business Practice Location Address:
208 BARNABY CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INCHELIUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99138-9565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-738-6245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007