Provider First Line Business Practice Location Address:
204 W 1ST AVE
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:
98841-0983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-826-1260
Provider Business Practice Location Address Fax Number:
509-826-3614
Provider Enumeration Date:
10/12/2006