Provider First Line Business Practice Location Address:
2384 HIGHWAY 141 # 482
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROUT LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98650-9735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-395-2134
Provider Business Practice Location Address Fax Number:
509-395-2144
Provider Enumeration Date:
06/26/2006