Provider First Line Business Practice Location Address:
1005 S CANYON 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:
98926-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-426-3730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2019