Provider First Line Business Practice Location Address:
626 SECOND AVENUE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKANOGAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98840-9679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-7605
Provider Business Practice Location Address Fax Number:
509-422-7608
Provider Enumeration Date:
03/31/2008