Provider First Line Business Practice Location Address:
613 N PINE ST
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:
98926-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-904-7721
Provider Business Practice Location Address Fax Number:
509-248-3644
Provider Enumeration Date:
11/19/2008