Provider First Line Business Practice Location Address:
104 W 5TH AVE
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:
98926-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-929-3540
Provider Business Practice Location Address Fax Number:
509-962-9774
Provider Enumeration Date:
01/04/2008