Provider First Line Business Practice Location Address:
416 N PEARL ST OFC 4
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:
98926-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-891-2695
Provider Business Practice Location Address Fax Number:
877-206-8818
Provider Enumeration Date:
10/13/2012