Provider First Line Business Practice Location Address:
707 N PEARL ST STE K
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:
98926-2938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-2492
Provider Business Practice Location Address Fax Number:
509-962-5836
Provider Enumeration Date:
08/30/2006