Provider First Line Business Practice Location Address:
901 SHUMWAY RD
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:
98841-9798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-846-7700
Provider Business Practice Location Address Fax Number:
509-826-5248
Provider Enumeration Date:
07/26/2006