Provider First Line Business Practice Location Address:
298 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-2221
Provider Business Practice Location Address Fax Number:
509-684-6222
Provider Enumeration Date:
09/08/2009