Provider First Line Business Practice Location Address:
103 E 4TH AVE STE 208B
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:
98926-3189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-607-0287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2007