Provider First Line Business Practice Location Address:
162 S MAIN ST
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:
99114-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-1420
Provider Business Practice Location Address Fax Number:
509-684-6293
Provider Enumeration Date:
09/15/2014