Provider First Line Business Practice Location Address:
108 SECOND AVENUE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKANOGAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98840-0151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-3200
Provider Business Practice Location Address Fax Number:
509-422-2339
Provider Enumeration Date:
10/13/2006