Provider First Line Business Practice Location Address:
550 E BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REARDAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-796-2737
Provider Business Practice Location Address Fax Number:
509-796-2738
Provider Enumeration Date:
06/16/2006