Provider First Line Business Practice Location Address:
220 25TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-4097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-884-0602
Provider Business Practice Location Address Fax Number:
509-884-0602
Provider Enumeration Date:
01/31/2007