Provider First Line Business Practice Location Address:
108 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-260-1226
Provider Business Practice Location Address Fax Number:
509-674-2833
Provider Enumeration Date:
05/14/2007