Provider First Line Business Practice Location Address:
110 W ANNIE PL
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:
98926-3093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-914-6986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2025