Provider First Line Business Practice Location Address:
601 N ANDERSON 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:
98926-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-775-6774
Provider Business Practice Location Address Fax Number:
360-841-7417
Provider Enumeration Date:
12/24/2009