Provider First Line Business Practice Location Address:
126 E JOHNSON
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:
98816-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-682-2708
Provider Business Practice Location Address Fax Number:
509-682-2713
Provider Enumeration Date:
06/20/2006