Provider First Line Business Practice Location Address:
304 GRANT ROAD
Provider Second Line Business Practice Location Address:
SUITE #1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-884-4200
Provider Business Practice Location Address Fax Number:
509-884-4201
Provider Enumeration Date:
09/25/2013