Provider First Line Business Practice Location Address:
232 SECOND AVE N
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:
98840-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-4881
Provider Business Practice Location Address Fax Number:
509-422-4053
Provider Enumeration Date:
09/14/2016