Provider First Line Business Practice Location Address:
298 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-685-0998
Provider Business Practice Location Address Fax Number:
509-684-8685
Provider Enumeration Date:
06/18/2007