Provider First Line Business Practice Location Address:
700 E MANITOBA AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-6947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006