Provider First Line Business Practice Location Address:
988 1ST CRK RD
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:
98816-9377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-687-9142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2008