Provider First Line Business Practice Location Address:
24010 WHITE RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-9543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-972-7917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2015