Provider First Line Business Practice Location Address:
125 S MEYERS ST
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:
99141-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-690-7760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2019