Provider First Line Business Practice Location Address:
2205 W DOLARWAY RD STE 2
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:
98926-8228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-3850
Provider Business Practice Location Address Fax Number:
206-215-3870
Provider Enumeration Date:
05/02/2011