Provider First Line Business Practice Location Address:
407 E JOHNSON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-630-9917
Provider Business Practice Location Address Fax Number:
509-682-3373
Provider Enumeration Date:
11/14/2007