Provider First Line Business Practice Location Address:
507 N PINE ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-1525
Provider Business Practice Location Address Fax Number:
509-925-1526
Provider Enumeration Date:
05/28/2008