Provider First Line Business Practice Location Address:
1006 N ALDER ST
Provider Second Line Business Practice Location Address:
#10
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-220-0292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2015