Provider First Line Business Practice Location Address:
503 E HIGHLAND 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:
98816-8631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-682-8517
Provider Business Practice Location Address Fax Number:
509-682-6131
Provider Enumeration Date:
03/05/2007