Provider First Line Business Practice Location Address:
411 E SADDLE MOUNTAIN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTAWA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-932-4565
Provider Business Practice Location Address Fax Number:
509-932-4571
Provider Enumeration Date:
10/23/2006