Provider First Line Business Practice Location Address:
603 S CHESTNUT ST
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:
98926-3875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-8619
Provider Business Practice Location Address Fax Number:
509-962-7351
Provider Enumeration Date:
04/09/2007