Provider First Line Business Practice Location Address:
11779 US HIGHWAY 2
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-548-0784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2009