Provider First Line Business Practice Location Address:
1206 N DOLARWAY RD
Provider Second Line Business Practice Location Address:
118
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-8392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-7867
Provider Business Practice Location Address Fax Number:
509-925-7871
Provider Enumeration Date:
08/06/2015