Provider First Line Business Practice Location Address:
136 E JOHNSON AVE, STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816-9904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-5477
Provider Business Practice Location Address Fax Number:
509-888-5352
Provider Enumeration Date:
01/24/2012