Provider First Line Business Practice Location Address:
1118 SOUTH 5TH AVE.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-733-1488
Provider Business Practice Location Address Fax Number:
509-422-1639
Provider Enumeration Date:
01/11/2013