Provider First Line Business Practice Location Address:
1942 BAR 14 RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-7338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-426-7008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2008