Provider First Line Business Practice Location Address:
305 N ANDERSON
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:
98926-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-9633
Provider Business Practice Location Address Fax Number:
509-962-9634
Provider Enumeration Date:
01/26/2007