Provider First Line Business Practice Location Address:
202 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-1154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-674-5057
Provider Business Practice Location Address Fax Number:
509-674-6946
Provider Enumeration Date:
01/15/2025