Provider First Line Business Practice Location Address:
22 WEST HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOAP LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-9606
Provider Business Practice Location Address Fax Number:
509-246-8001
Provider Enumeration Date:
12/18/2012