Provider First Line Business Practice Location Address:
154 E 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-3592
Provider Business Practice Location Address Fax Number:
509-685-9118
Provider Enumeration Date:
10/22/2009