Provider First Line Business Practice Location Address:
118 S WHITCOMB AVE
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:
98855-9287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-486-3191
Provider Business Practice Location Address Fax Number:
509-223-1743
Provider Enumeration Date:
06/07/2006