Provider First Line Business Practice Location Address:
298 S. MAIN ST.
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-7640
Provider Business Practice Location Address Fax Number:
509-684-7640
Provider Enumeration Date:
02/13/2018