Provider First Line Business Practice Location Address:
108 2ND AVE SOUTH
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:
206-765-6998
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2013