Provider First Line Business Practice Location Address:
140 N COLUMBIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99326-0070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-234-2415
Provider Business Practice Location Address Fax Number:
509-234-2414
Provider Enumeration Date:
11/07/2006