Provider First Line Business Practice Location Address:
150 S ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-3584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2024