Provider First Line Business Practice Location Address:
2211 W DOLARWAY RD STE 4
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:
98926-8227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-7246
Provider Business Practice Location Address Fax Number:
509-933-4104
Provider Enumeration Date:
09/20/2006