Provider First Line Business Practice Location Address:
330 N MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEKOA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99033-9772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-284-4501
Provider Business Practice Location Address Fax Number:
509-286-3737
Provider Enumeration Date:
12/20/2005