Provider First Line Business Practice Location Address:
410 W LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COULEE CITY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-632-5231
Provider Business Practice Location Address Fax Number:
509-632-5166
Provider Enumeration Date:
07/04/2006