Provider First Line Business Practice Location Address:
21 FOURTH AVE. W.
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:
98841-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-1054
Provider Business Practice Location Address Fax Number:
509-422-1054
Provider Enumeration Date:
04/16/2008