Provider First Line Business Practice Location Address:
208 W FOURTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98841-0551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-826-2111
Provider Business Practice Location Address Fax Number:
509-826-1334
Provider Enumeration Date:
10/21/2006