Provider First Line Business Practice Location Address:
112 W RAILROAD ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-241-8003
Provider Business Practice Location Address Fax Number:
509-824-6715
Provider Enumeration Date:
08/07/2022