Provider First Line Business Practice Location Address:
1028B OLD HIGHWAY 12 MILE RD
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:
99114-8765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-685-0341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2007