Provider First Line Business Practice Location Address:
113 N WRIGHT AVE
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:
98922-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-715-0374
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2012