Provider First Line Business Practice Location Address:
13513 E. FRIDEGER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-991-4569
Provider Business Practice Location Address Fax Number:
509-292-8695
Provider Enumeration Date:
12/18/2023