Provider First Line Business Practice Location Address:
820 W UMPTANUM RD
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:
98926-8958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-899-4650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2010