Provider First Line Business Practice Location Address:
414 E WOODIN AVE
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:
98816-9648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-293-6809
Provider Business Practice Location Address Fax Number:
509-888-2231
Provider Enumeration Date:
02/13/2006