Provider First Line Business Practice Location Address:
11779 HIGHWAY 2 STE 105
Provider Second Line Business Practice Location Address:
MITTENWALDER PLATZ
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-860-5309
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2011