Provider First Line Business Practice Location Address:
849 SALMON CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKANOGAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98840-9708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-429-8530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2012