Provider First Line Business Practice Location Address:
603 S CHESTNUT ST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-8484
Provider Business Practice Location Address Fax Number:
509-925-8485
Provider Enumeration Date:
02/13/2017