Provider First Line Business Practice Location Address:
219 E. JOHNSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816-0368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-682-2511
Provider Business Practice Location Address Fax Number:
509-682-2515
Provider Enumeration Date:
11/01/2006