Provider First Line Business Practice Location Address:
902 ENGH 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:
98841-9473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-846-3930
Provider Business Practice Location Address Fax Number:
509-288-4269
Provider Enumeration Date:
08/16/2006