Provider First Line Business Practice Location Address:
470 9TH ST NE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-7661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-433-1068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007