Provider First Line Business Practice Location Address:
427 S OAK ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-846-6367
Provider Business Practice Location Address Fax Number:
509-685-9600
Provider Enumeration Date:
11/05/2009