Provider First Line Business Practice Location Address:
667 GRANT RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-7818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-860-4133
Provider Business Practice Location Address Fax Number:
509-881-2633
Provider Enumeration Date:
09/10/2010