Provider First Line Business Practice Location Address:
321 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-548-5415
Provider Business Practice Location Address Fax Number:
509-548-2434
Provider Enumeration Date:
12/01/2005