Provider First Line Business Practice Location Address:
325 E 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTLE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99141-9551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-652-8654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2016