Provider First Line Business Practice Location Address:
505 NORTH PIERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KITTITAS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-968-3014
Provider Business Practice Location Address Fax Number:
509-968-4730
Provider Enumeration Date:
11/08/2006