Provider First Line Business Practice Location Address:
325 E 3RD AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTLE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99141-9551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-640-3288
Provider Business Practice Location Address Fax Number:
833-428-2249
Provider Enumeration Date:
12/08/2014