Provider First Line Business Practice Location Address:
1521 MEDINA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-6223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-6903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2013