Provider First Line Business Practice Location Address:
1203 E CAPITOL AVE
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:
98926-9452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-8361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2014