Provider First Line Business Practice Location Address:
155 STATE HWY 28 W
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:
98851-9610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-246-0321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2023