Provider First Line Business Practice Location Address:
440 S MEYERS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTLE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-738-1555
Provider Business Practice Location Address Fax Number:
509-738-1554
Provider Enumeration Date:
06/17/2008