Provider First Line Business Practice Location Address:
608 E MOUNTAINVIEW
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-6996
Provider Business Practice Location Address Fax Number:
509-962-5322
Provider Enumeration Date:
03/02/2012