Provider First Line Business Practice Location Address:
2650 ENTIAT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENTIAT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98822-9710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-784-1800
Provider Business Practice Location Address Fax Number:
509-784-2986
Provider Enumeration Date:
07/04/2006