Provider First Line Business Practice Location Address:
850 CAMP KOINONIA LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-8820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-304-9541
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2026