Provider First Line Business Practice Location Address:
35 STATE HWY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONASKET
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98855-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-240-2889
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2021