Provider First Line Business Practice Location Address:
860 KENROY TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-6048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-884-5544
Provider Business Practice Location Address Fax Number:
509-886-8531
Provider Enumeration Date:
12/02/2013