Provider First Line Business Practice Location Address:
230 GRANT RD STE A25
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-7722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-884-9040
Provider Business Practice Location Address Fax Number:
509-884-9041
Provider Enumeration Date:
10/24/2013