Provider First Line Business Practice Location Address:
1201 E HELENA AVE APT 13108
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:
98926-8253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-864-1805
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2025