Provider First Line Business Practice Location Address:
1107 S NEW OAK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-5447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-300-7828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2025