Provider First Line Business Practice Location Address: 
1815 VALLEY VUE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WENATCHEE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98801-1050
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-888-5676
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/04/2006