Provider First Line Business Practice Location Address:
784 N KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-6061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-393-3575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2020