Provider First Line Business Practice Location Address:
833 FRONT ST
Provider Second Line Business Practice Location Address:
SUITE 34
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-548-2192
Provider Business Practice Location Address Fax Number:
509-548-2192
Provider Enumeration Date:
07/25/2006