Provider First Line Business Practice Location Address:
112 W RAILROAD ST
Provider Second Line Business Practice Location Address:
SUITE #200
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-674-5344
Provider Business Practice Location Address Fax Number:
509-674-5704
Provider Enumeration Date:
02/02/2009