Provider First Line Business Practice Location Address:
913 N PFENNING RD
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:
98926-9595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-607-9054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2014