Provider First Line Business Practice Location Address:
105 N PENNSYLVANIA AVE
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:
98922-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-674-0908
Provider Business Practice Location Address Fax Number:
509-674-0920
Provider Enumeration Date:
02/07/2006