Provider First Line Business Practice Location Address:
144 E JOHNSON AVE UNIT 1325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816-9484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-369-3068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006