Provider First Line Business Practice Location Address:
414 E. WOODIN 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:
98816-9648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-2209
Provider Business Practice Location Address Fax Number:
509-888-9449
Provider Enumeration Date:
08/27/2009