Provider First Line Business Practice Location Address:
2696 STATE ROUTE 903
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-8704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-649-4700
Provider Business Practice Location Address Fax Number:
509-649-2074
Provider Enumeration Date:
11/30/2017