Provider First Line Business Practice Location Address:
407 EAST WOODIN AVE.
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:
98816-9648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-682-4031
Provider Business Practice Location Address Fax Number:
509-682-8291
Provider Enumeration Date:
10/31/2012