Provider First Line Business Practice Location Address:
130 N ADAMS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COULEE CITY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-632-8668
Provider Business Practice Location Address Fax Number:
509-632-5761
Provider Enumeration Date:
02/02/2010