Provider First Line Business Practice Location Address:
203 2ND AVE S
Provider Second Line Business Practice Location Address:
SUITE 112
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:
509-557-6300
Provider Business Practice Location Address Fax Number:
509-557-6380
Provider Enumeration Date:
04/25/2022