Provider First Line Business Practice Location Address:
251 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-2330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-4243
Provider Business Practice Location Address Fax Number:
509-684-4289
Provider Enumeration Date:
07/26/2006