Provider First Line Business Practice Location Address:
214 E. CHELAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-989-5969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2009