Provider First Line Business Practice Location Address:
2690 SR 903
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-649-4707
Provider Business Practice Location Address Fax Number:
509-649-3634
Provider Enumeration Date:
02/27/2013