Provider First Line Business Practice Location Address:
2006 LOTZE CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-732-4240
Provider Business Practice Location Address Fax Number:
509-732-6114
Provider Enumeration Date:
10/04/2006