Provider First Line Business Practice Location Address:
109 N RUBY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-1354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2008