Provider First Line Business Practice Location Address:
200 E 3RD 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:
98926-3347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-9821
Provider Business Practice Location Address Fax Number:
509-925-9073
Provider Enumeration Date:
04/06/2007