Provider First Line Business Practice Location Address:
230 GRANT ROAD SUITE B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-7723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-6334
Provider Business Practice Location Address Fax Number:
877-682-0175
Provider Enumeration Date:
05/02/2008