Provider First Line Business Practice Location Address:
1840 LAWRENCE 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:
98926-8684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-713-4096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2007