Provider First Line Business Practice Location Address:
116 N OAKES AVE STE A2
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:
98922-1273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-961-0547
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2011