Provider First Line Business Practice Location Address:
41 BYNUM RD
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:
98926-5279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-607-0250
Provider Business Practice Location Address Fax Number:
509-968-3249
Provider Enumeration Date:
04/29/2008