Provider First Line Business Practice Location Address:
1127 GRANT RD
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:
98802-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-2768
Provider Business Practice Location Address Fax Number:
509-888-2768
Provider Enumeration Date:
07/17/2012