Provider First Line Business Practice Location Address:
701 N WATER ST
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:
98926-2855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-999-2162
Provider Business Practice Location Address Fax Number:
888-538-7694
Provider Enumeration Date:
05/06/2026