Provider First Line Business Practice Location Address:
700 E MANITOBA AVE STE 109
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:
98926-3885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-8445
Provider Business Practice Location Address Fax Number:
509-925-8464
Provider Enumeration Date:
07/31/2006