Provider First Line Business Practice Location Address:
103 E 4TH AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-1196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2012