Provider First Line Business Practice Location Address:
11779 US HIGHWAY 2 STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-699-9917
Provider Business Practice Location Address Fax Number:
509-398-9629
Provider Enumeration Date:
03/08/2021