Provider First Line Business Practice Location Address:
739 HAUSSLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98841-9547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-826-5040
Provider Business Practice Location Address Fax Number:
509-826-9436
Provider Enumeration Date:
11/24/2009