Provider First Line Business Practice Location Address:
321 9TH ST
Provider Second Line Business Practice Location Address:
# 206
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-630-9784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007