Provider First Line Business Practice Location Address:
807 W GOLF COURSE DR
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:
98816-9577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-387-5563
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2026