Provider First Line Business Practice Location Address:
700 S. MAIN 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:
509-925-4232
Provider Business Practice Location Address Fax Number:
509-925-6065
Provider Enumeration Date:
10/01/2009