Provider First Line Business Practice Location Address:
130 W 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTLE FALLS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99141-8666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-738-6880
Provider Business Practice Location Address Fax Number:
509-738-6824
Provider Enumeration Date:
01/04/2007