Provider First Line Business Practice Location Address:
116 E 1ST ST
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-674-2343
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2007