Provider First Line Business Practice Location Address:
617 5TH AND BENTON
Provider Second Line Business Practice Location Address:
PO BOX C
Provider Business Practice Location Address City Name:
OMAK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-7737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2009