Provider First Line Business Practice Location Address:
305 W 11TH AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-2954
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2007