Provider First Line Business Practice Location Address:
27 N MAIN ST
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:
98841-0513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-826-0870
Provider Business Practice Location Address Fax Number:
509-826-4761
Provider Enumeration Date:
12/18/2006