Provider First Line Business Practice Location Address:
5241 UMPTANUM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-6989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-899-9083
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2017