Provider First Line Business Practice Location Address:
902 ENGH 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:
98841-9473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-826-8021
Provider Business Practice Location Address Fax Number:
509-826-2556
Provider Enumeration Date:
05/29/2023