Provider First Line Business Practice Location Address:
820 CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-322-8254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2007