Provider First Line Business Practice Location Address:
705 S MAPLE 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:
98926-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-244-2982
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2008