Provider First Line Business Practice Location Address:
601 N BAKER AVE APT 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-4469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-393-9871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2013