Provider First Line Business Practice Location Address:
1200 E COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-3701
Provider Business Practice Location Address Fax Number:
509-684-4180
Provider Enumeration Date:
10/12/2005