Provider First Line Business Practice Location Address:
309 E 2ND AVE
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:
98926-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-6172
Provider Business Practice Location Address Fax Number:
509-962-3864
Provider Enumeration Date:
02/27/2007