Provider First Line Business Practice Location Address:
502 W ILLINOIS 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:
98926-2481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-899-5143
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2019