Provider First Line Business Practice Location Address:
230 GRANT RD
Provider Second Line Business Practice Location Address:
SUITE B6
Provider Business Practice Location Address City Name:
E WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-5383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-663-4602
Provider Business Practice Location Address Fax Number:
509-665-4289
Provider Enumeration Date:
10/27/2005