Provider First Line Business Practice Location Address:
25193 HIGHWAY 395 N
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:
99141-5006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-738-2476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2020