Provider First Line Business Practice Location Address:
304 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
COULEE DAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99116-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-633-0700
Provider Business Practice Location Address Fax Number:
509-633-3063
Provider Enumeration Date:
04/24/2007