Provider First Line Business Practice Location Address:
303 E. JOHNSON AVENUE
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:
98816-0369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-682-3515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2007