Provider First Line Business Practice Location Address:
551 11TH ST NE APT A
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:
98802-4262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-670-6969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2025