Provider First Line Business Practice Location Address:
201 S WATER
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:
98928-8907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-0533
Provider Business Practice Location Address Fax Number:
509-962-0527
Provider Enumeration Date:
03/16/2012