Provider First Line Business Practice Location Address:
626 2ND AVE SOUTH
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:
98840-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-6705
Provider Business Practice Location Address Fax Number:
509-422-6708
Provider Enumeration Date:
06/27/2006