Provider First Line Business Practice Location Address:
982 E COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-2561
Provider Business Practice Location Address Fax Number:
509-685-2492
Provider Enumeration Date:
06/01/2006