Provider First Line Business Practice Location Address:
290 OASIS LN
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:
98926-6552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-279-9851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2025