Provider First Line Business Practice Location Address:
3381 N CAFFELL RD
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:
99109-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-671-1721
Provider Business Practice Location Address Fax Number:
509-445-0646
Provider Enumeration Date:
03/25/2013