Provider First Line Business Practice Location Address:
424 2ND AVE S
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:
98840-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-422-4041
Provider Business Practice Location Address Fax Number:
509-826-7339
Provider Enumeration Date:
08/25/2023