Provider First Line Business Practice Location Address:
204 E 6TH 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:
98926-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-899-0148
Provider Business Practice Location Address Fax Number:
509-962-5883
Provider Enumeration Date:
12/20/2017