Provider First Line Business Practice Location Address:
109 E 3RD AVE STE 1
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:
98926-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-4325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2009