Provider First Line Business Practice Location Address:
150 S ELM 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:
99114-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-675-1447
Provider Business Practice Location Address Fax Number:
509-684-3852
Provider Enumeration Date:
04/27/2015