Provider First Line Business Practice Location Address:
208 N ANDERSON ST
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:
98926-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-923-9469
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2018