Provider First Line Business Practice Location Address:
2264 C. SAND CANYON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEWELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-385-9980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2007