Provider First Line Business Practice Location Address:
236 N. 2ND AVE.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-9958
Provider Business Practice Location Address Fax Number:
509-422-9998
Provider Enumeration Date:
02/10/2012