Provider First Line Business Practice Location Address:
1801 N CHESTNUT ST APT 2
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:
98926-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-990-7488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2025