Provider First Line Business Practice Location Address:
611 S CHESTNUT STREET, SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-7390
Provider Business Practice Location Address Fax Number:
509-925-6948
Provider Enumeration Date:
12/30/2005