Provider First Line Business Practice Location Address:
109 PEONEY CREEK RD
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:
98855-9510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-486-1260
Provider Business Practice Location Address Fax Number:
866-626-4289
Provider Enumeration Date:
07/16/2013