Provider First Line Business Practice Location Address:
149 4TH AVE N
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:
98840-9437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-7230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2007